1. Hip Joint
Rania Gabr

2. Objectives Know the type and formation of hip joint.
Differentiate the stability and mobility between the hip joint and shoulder joint.
Identify the muscles that act at the hip joint.

3. Type & Articular Surfaces
Synovial, ball & socket joint.
Articular Surfaces:
Acetabulum of hip (pelvic) bone
Head of femur
The lunate surface  and the head of the femur(except for the fovea) are covered by hyaline cartilage
The nonarticular acetabular fossa contains loose connective tissue.

4. Acetabular labrum:
C-shaped fibro-cartilaginous collar attached to margins of acetabulum, increases its depth for better retaining of head of femur.

5. Capsule
The hip joint is enclosed within strong fibrous capsule lined by synovial membrane .
Proximally:
it is attached to the acetabulum, and to the transverse acetabular ligament .
Distally:
Anteriorly: covers the neck & is attached to intertrochanteric line
Posteriorly: covers medial half of the neck of femur

6. POSTERIOR
ANTERIOR
Intertrochanteric line

7. Synovial Membrane
The synovial membrane lines the capsule and the nonarticular surfaces.
It reflects along the femoral neck to the edge of the femoral head

8. The arteries that supply the femoral head and neck course within the synovial folds.
They are called retinacular vessels

9. Ligaments: 3 Extracapsular
Pubofemoral ligament:
Located antero-inferior to joint
Limits abduction & lateral rotation
Iliofemoral ligament:
Y-shaped
Located anterior to joint
Limits extension
Ischiofemoral ligament:
Located posterior to joint
Limits medial rotation

10. Ligaments: 2 Intracapsular (Extrasynovial)
Ligament of femoral head: carries vessels to head of femur
Transverse acetabular ligament:
formed by the acetabular labrum as it bridges the acetabular notch
converts acetabular notch into foramen through which pass acetabular vessels

12. Movements of the hip
Flexion.
Extension,

13. Abduction.
Adduction.

14. Medial and lateral rotation.
Circumduction.

15. Hip Flexion Psoas Major Iliopsoas(composite muscle)
Chief flexor of HIP:
Psoas major
iliacus
Origin:
1- Anterior surfaces of the transverse processes of T12-L5 vertebrae
2- Upper two thirds of the iliacus
Insertion: 
Lesser trochanter of the femur after being joined by the iliacus
Action: 
1-Flexion of thigh at hip
2- Assists in extension of the lumbar spine
3. Lateral Flexion of the spine when acting unilaterally
Innervation: 
Lumbar plexus (L2,3,4)
Psoas Major

16. Iliacus Origin Iliac fossa within abdomen
Insertion Lowermost surface of lesser trochanter of femur, after joining psoas
Action Flexes &laterally rotates hip
Nerve Femoral nerve in abdomen (L2,3)

17. Hip extension Gluteal region:
iliotibial tract
Tensor
Fasciae
Latae
Gluteus
maximus
Gluteal region:
-Gluteus maximus
(most powerful extensor,
also lateral rotator)
Insertion:
Gluteal tuberosity +
Iliotibial tract (band)
gluteus maximus
Gluteus Maximus and Tensor Fascia Lata insert into Iliotibial Tract
- Iliotibial tract is a thickening of the deep fascia (fascia lata) that extends from the ilium to the tibia.
- Tension from contraction of gluteus maximus and tensor fasciae latae stabilizes the lower limb as a weight-bearing column.

18. Hip Adduction Medial Compartment main function = adduction
Obturator externus
Adductor brevis
Adductor longus
Adductor magnus
Gracilis
Most innervated by:
Obturator nerve (L2-L4)
(lumbar plexus)
Exception:
-Hamstring component of
adductor magnus (extensor)
(tibial division of sciatic nerve)
obturator
externus
obturator
nerve
adductor brevis
Adductor
magnus
adductor longus
gracilis

19. Lateral Rotation of the hip
gluteus medius
gluteus
maximus
gluteus minimus
Deep to gluteus maximus:
-Abductors:
gluteus medius
gluteus minimus
(anterior fibres medially rotate)
-Lateral (external) rotators:
piriformis
obturator internus
(associated gemelli)
quadratus femoris
[obturator externus is also a
lateral rotator]
piriformis
superior
gamellus
obturator
internus
quadratus
femoris
inferior
gamellus

20. Movements of the Hip Joint (ball and socket)
Summary
Movements of the Hip Joint (ball and socket)
Flexion Anterior + medial compartments of thigh
(iliopsoas, sartorius, rectus femoris, adductor) group)
Extension - Gluteal region /posterior compartment of thigh
(gluteus maximus, hamstrings, adductor magnus)
Adduction - Medial (adductor) compartment of thigh
Abduction - gluteus medius & minimus, Tensor Fascia Lata
Rotation:
Lateral - Gluteus maximus, lateral rotators
Medial - anterior parts of gluteus medius & minimus,
+ Tensor Fascia Lata

21. Vascular supply to the hip joint
1- Obturator artery.
2-Medial &
3-Lateral circumflex femoral arteries.
4- Superior and inferior gluteal arteries.
5- First perforating branch of the deep artery of the thigh.
The articular branches of these vessels form a network(anatomosis) around the joint .

23. Nerve Supply of the hip joint
The hip joint is innervated by articular branches (Hilton’s Law) from:
Femoral.
Obturator.
Superior gluteal nerves
Nerve to the quadratus femoris.
Sciatic nerve.

24. Applied anatomy Perthes disease
Perthes' disease is a condition where the top of the thigh bone in the hip joint (the femoral head) softens and breaks down. It occurs in some children and causes a limp and other symptoms. The bone gradually heals and reforms as the child grows. The aim of treatment is to make sure the femoral head reforms back into its normal shape so that the hip joint can work well.

25. Coxa vara and Coxa Valga

26. Avascular Necrosis of the Head of the Femur